Overview of the NCDB Report
The second annual report from the National Cancer Database (NCDB) of the American College of Surgeons (ACS) indicates a significant increase in the use of medications such as chemotherapy, immunotherapy, and hormone therapy before surgery for various cancers. This approach, known as neoadjuvant systemic therapy, may enable less invasive surgical procedures and assist clinicians in evaluating a patient's cancer response to medication, thereby guiding optimal treatment choices.
The report, published in the Journal of the American College of Surgeons (JACS), also includes comprehensive data on esophageal, melanoma, and prostate cancers. The NCDB, a joint initiative by the ACS and the American Cancer Society, gathers data from approximately 75% of cancer cases across the United States. It includes metrics like tumor biology and hospital stay duration. The report summarizes data from over 22 million cancer cases diagnosed at 1,250 CoC hospitals between 2004 and 2022.
Ronald J. Weigel, MD, PhD, MBA, FACS, medical director of ACS Cancer Programs and co-author, stated that the report aims to inform researchers and the public about cancer observations, treatment advancements, surgical options, and outcomes.
Trends in Neoadjuvant Systemic Therapy
The report highlights notable increases in neoadjuvant systemic therapy for specific cancers from 2010 to 2022:
- For gynecologic cancers, usage rose almost fivefold, from 7% to 34%.
- For pancreatic cancer, usage more than tripled, from 12% to 40%.
- For rarer abdominal lining cancers (peritoneum, omentum, mesentery), usage nearly doubled, from 23% to 47%.
Judy C. Boughey, MD, FACS, senior author of the JACS study, explained that this shift allows for tumor shrinkage, potentially leading to less invasive surgery. It also provides insights into a tumor's response to systemic treatment, which informs subsequent therapy decisions.
Detailed Findings for Specific Cancers
The report provided in-depth data on prostate, esophageal, and melanoma cancers.
Prostate Cancer
Prostate cancer patients are increasingly receiving non-surgical treatments, particularly those with Stage 1 disease. In 2022, approximately 60% of prostate cancer patients received non-surgical treatments, up from 54% in 2018. For patients undergoing surgery, prostatectomy was the most common procedure, performed in 85% of surgical cases. Risk factors associated with mortality included PSA levels over 20 at diagnosis, along with higher cancer stage and tumor grade.
Esophageal Cancer
Immunotherapy use for esophageal cancer increased from 8% to 30% between 2018 and 2022. However, about half of patients are diagnosed with stage 4 disease. Researchers advocate for the development of effective, widely used screening methods to detect esophageal cancer earlier.
Melanoma
Melanoma most frequently affected the torso (30%) and the upper limb and shoulder region (25%). Scalp and neck melanomas exhibited the lowest overall survival rates among invasive melanomas. The presence of ulceration was also linked to poorer survival outcomes.